DENTAL DISEASES AND ORAL HEALTH

FACTS:
• Dental diseases are the most prevalent globally; an estimated 5 billion people suffer from
tooth decay
• Dental disease treatment accounts for between 5% and 10% of total health care costs in
industrialized countries
• More than 40% of older people in Albania, Bosnia & Herzogovina, Bulgaria, Canada, Finland,
Malaysia and the UK, suffer from total tooth loss.

DENTAL DISEASES AND ORAL HEALTH DEFINING DENTAL DISEASE

Dental diseases are the most prevalent chronic diseases Dental diseases include dental caries, developmental
worldwide, and a costly burden to health care services.The defects of enamel, dental erosion and periodontal disease.
treatment of dental diseases is expensive, accounting for
between 5% and 10% of total health care expenditures in
industrialized countries. In most developing low-income
Dental caries
countries, the prevalence rate of dental caries is high and Dental caries occurs due to demineralization of enamel and
more than 90% of caries is untreated. An estimated 5 billion dentine (the hard tissues of the teeth) by organic acids
people worldwide suffer from dental caries (tooth decay). formed by bacteria in dental plaque.This process is due to
the anaerobic metabolism of sugars derived from the diet.
When sugars or other fermentable carbohydrates are
Nutrition affects the teeth and growth of the jaw during
ingested, the resulting fall in dental plaque pH caused by
development. While malnutrition may exacerbate
organic acids increases the solubility of the dental hard
periodontal and oral infectious diseases, the most
tissues and demineralization occurs as calcium is lost. The
significant effect of nutrition is the local action of diet in
development of caries requires sugars and bacteria to occur,
the mouth, particularly in the development of dental caries
but is influenced by the susceptibility of the tooth, the
and enamel erosion. Dental caries is largely caused by
bacterial profile, quantity and quality of the saliva, low levels
sugars. Dental erosion is associated with dietary acids, a
of fluoride, and the time for which fermentable dietary
major source of which is soft drinks.A typical soft drink may
carbohydrates are available for bacterial fermentation (i.e.
contain the equivalent of up to 20 teaspoons of sugar.
the frequency of sugar intake).
Despite a low mortality rate associated with dental diseases,
they have a considerable impact on self-esteem, eating
ability, nutrition and health both in childhood and older age. Dental erosion
Dental erosion is the progressive irreversible loss of dental
hard tissue that is chemically etched away from the tooth
WHY IS THIS HAPPENING? surface by dietary extrinsic and/or intrinsic acids. Erosion is
often associated with other forms of tooth wear such as
Oral health is related to diet in several ways, for example, abrasion and attrition (from overzealous oral hygiene,
nutritional influences on cranio-facial development and salivary work-related exposure to industrial inorganic dust, and
glands, oral cancer and oral infectious diseases. Diet plays an grinding of teeth, for example). Poor salivary flow or
important role in dental caries, a major cause of tooth loss. salivary deficiencies are thought to make some individuals
Diet also plays a significant role in dental erosion, a condition more susceptible. Erosion reduces the size of the teeth and
which seems to be becoming more prevalent worldwide.And in severe cases leads to total tooth destruction.
dietary components may also contribute to development of
enamel defects. Periodontal disease, another cause of tooth
loss in adults, is largely related to the use of tobacco. Oral
cancer is also largely caused by the use of tobacco (smoking
and chewing), as well as excessive use of alcohol.

There is convincing evidence, collectively from human

intervention studies, epidemiological studies, animal studies
and experimental studies, for an association between the
amount and frequency of free sugars intake and dental caries.
Nutritional status affects teeth pre-eruptively, though this is
© WHO 2003

much less important than the post-eruptive local effect of

diet. Undernutition, coupled with a high intake of sugars, may
exacerbate caries.

WO R L D H E A LT H O R G A N I Z AT I O N

GLOBAL STRATEGY ON
DIET, PHYSICAL ACTIVITY AND HEALTH
 DENTAL DISEASES AND ORAL HEALTH

Periodontal disease that in all countries covered by the survey,substantial numbers

Periodontal disease mostly becomes apparent in middle age. of children and adults reported impaired social functioning due
Apart from severe vitamin C deficiency, which results in to oral disease, such as avoiding laughing or smiling due to
scurvy-related periodontitis, there is less evidence of an poor perceived appearance of teeth.
association between diet and periodontal disease. The main
overriding factor is the presence of plaque, and the use of Dental decay also results in tooth loss, which reduces the
tobacco. ability to eat a varied diet. It is in particular associated with
a diet low in fruits, vegetables and non-starch polysaccha-
rides (NSP), and with a low plasma vitamin C level. NSP
intakes of less than 10g per day and fruit and vegetable
THE EXTENT OF THE PROBLEM intakes of less that 160g per day have been reported in a
study of edentulous people (i.e., with no teeth at all).Tooth
Despite improved trends in levels of dental caries in developed loss may therefore impede the achievement of dietary goals
countries, the disease remains prevalent and is increasing in related to the consumption of fruits, vegetables and NSP.
some developing countries undergoing nutrition transition,
with limited exposure to fluorides. Within most countries,
geographical and social factors influence the occurrence of
WHAT CAN WE DO ABOUT IT?
dental caries and, despite improvements, caries continues to
affect the majority of children, some severely. Dental caries is
the most common dental disease in children and contributes In low-income countries, the cost of
to tooth loss in adults. traditional restorative treatment of
dental disease is disproportionately
expensive.The large financial benefits
In most developing low-income countries dental caries
of preventing dental diseases should
prevalence is severe as more than 90% is untreated. The
be emphasized. It is important that
level of caries is higher for the primary dentition than the
countries with a low intake of free
permanent dentition for children of several developing
sugars do not increase intake, as the
countries in Asia and Africa, as shown by recent studies for
available evidence shows that when
China,Thailand, Madagascar and Niger. Available data show
free sugars consumption is < 15-20
that the mean number of permanent teeth affected by
kg/year (~6-10% energy intake),
dental caries (DMFT) in populations at age 12 years of
dental caries is low. Other countries should aim towards a
low-income countries is 1.9 compared with 3.3 DMFT for
maximum of 10% of total calorie intake per day in free sugars.
middle income countries and 2.1 DMFT for high-income
In addition, the frequency of consumption of foods containing
countries. (dmft/DMFT is a count of the number of teeth in
free sugars should be limited to a maximum of four times per
a person’s mouth that are decayed, filled or missing, widely
day and adequate exposure to fluoride should be promoted.
used to indicate the prevalence of dental caries and the
severity of dental caries in primary teeth (dmft) or permanent
teeth (DMFT).
FOCUS ON THE YOUNG
CHANGING LEVELS OF DENTAL CARIES EXPERIENCE (DMFT)
AMONG 12 YEAR-OLDS IN DEVELOPED AND DEVELOPING COUNTRIES
Effective prevention should focus in particular on young
people. Needed actions include:
5
DEVELOPED COUNTRIES • Promoting healthy nutrition and oral hygiene practices
4
through school health programmes.
3
ALL COUNTRIES
• Providing nutritionally sound school lunches, which factor
DMFT

in the protective factors in milk and cheese.

2
DEVELOPING COUNTRIES
• Banning soft drink and snack vending machines, and the
1 sale of sweets and unhealthy foods inside or just outside
school premises.
0
1980 1984 1986 1989 1990 1991
1998 • Discourage linkages between sports and soft drinks.
• Promoting pre-natal good nutrition and breastfeeding for
at least six months.
Dental diseases have a detrimental effect on quality of life both
© WHO 2003

in childhood and older age. The second WHO International • Encouraging caregivers to support healthy dietary habits
Collaborative Study of Oral Health Systems (ICSII) revealed in children and the elderly.

KEY CONTACTS DR P. PUSKA Mr D. PORTER DR P.E. PETERSEN

World Health Organization World Health Organization World Health Organization
Tel: +41-22-791 4703 Tel: +41-22-791 3774 Tel: +41-22-791 3475
Fax: +41-22-791 4186 Fax: +41-22-791 4186 Fax: +41-22-791 4866
Email: puskap@who.int Email: porterd@who.int Email: petersenpe@who.int